Friday, May 11, 2012

Blind and toothless: The future of middle class in America?

Since it's Friday, we'll steer clear of academic subjects and just tell a story. This is a story of a good friend of mine who works in an editorial position for an interdisciplinary humanities journal. This journal is based at a prestigious private liberal arts institution, and thus she is on staff at that institution. This story is about her, but also about how well the Massachusetts health law is working for people like her. I will call her Jo.

Jo is in her early 50s, a single mom of two lovely teenage boys. Their father who is separated from Jo, although in the picture, does not provide any child support for various reasons. Thus she carries sole financial responsibility for her family.

Well, you say, she is on the journal's editorial staff, she is loaded, right? Nah, surely you are not so naïve as to think that this is a high-paid position at a humanities publication. Let's just say that she is not the 1%; why, she is not even in the top one-half. Would you believe me if I told you that a high-ranking editorial staffer gets a salary that is only 2x above the federal poverty level threshold? So much for those wealthy elite academic East Coast types! But she does get her healthcare insurance through her employer, and this is fortunate, right? Well, here is the rub.

Jo has a complex health condition that affects her entire body, including skin, teeth, eyes, heart, lungs and viscera. Despite this, she is optimistic, upbeat and one of the most patient parents I have ever met. But here is what gets her goat: it is the very fact that she gets her health insurance through her employer! How can this be?

Here is how. The cost of her basic restrictive HMO insurance through her employer is over $5,000 per year. And this flat rate is not affected by the salary level of the employee; in other words, the janitor and the university president get to pay the same amount of money for the same plan. In addition to this, her office visit copay is $20, and her medication co-pays are between $10 and $30 for a month's worth of medication. As you can imagine, for someone with a complicated chronic condition, these co-pays can add up quickly, and they do, to a shocking $2,500 per year. And this is before any allowance for the boys' medical needs or dental or eye care for any of them. Once you add everything up, Jo spends over 1/4 of her entire not-so-stellar income on healthcare. But if we do add dental and eye expenses into the mix (remember, her condition affects these organ systems as well), her healthcare expenditure comes to 40-50% of her annual income! And this is just for draconian restrictions of an HMO! AND, this does not cover all of the time that she spends on the phone finding providers that take her insurance and on schlepping miles away to see that single specialist that the HMO will pay for.

But wait, you say, you live in Massachusetts, the land of socialism, gay marriage and healthcare for all. Why can't she just dump this lousy and expensive employer-provided coverage and go to the Mass Connector, where everyone is equal and all get what they need for what they can pay? And furthermore, you say, isn't the PPACA, the new healthcare law of the land that is fashioned after Romneycare in MA, going to take the choice away from people and MAKE them get insurance through these exchanges rather than through their employers? Jo must be an idiot not to be taking advantage of this communist healthcare state! Hmmm, let's see now.

Jo has had a number of discussions with the staff at the Connector. And yes, you are right in that, if she switched to one of their plans, she would qualify for a plan very similar to her present one for about 1/5 of what she pays now. And the co-pays? Why those would shrink to $0 to $10. How's that for a deal? But here is the catch: According to people she has spoken with at the Connector, a person who has health insurance offered through her employer is not permitted by law to take advantage of the Connector deals if the employer plan offers coverage that meets the minimum standard in the law. And hers does. Ironic, isn't it?

So Jo goes on struggling with the financial burden of her crappy and expensive employer-provided insurance, only now she has to pick and choose: Can she afford to replace her failing dental bridge ($4,700) or should she just choose something so frivolous as feeding her children instead? This is a choice that is not a choice at all, is it? And if these are the choices that we can expect with the PPACA, well, then, we have the law that we deserve: one that will make sure that the investors in the "healthcare" marketplace continue to get handsome returns. But start getting used to people who cannot see their computer screens showing up to work without their teeth!        

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